Dr. Schoenfield served as associate professor of medicine and consultant in gastroenterology on the faculty of the Mayo Clinic for seven years. He became a professor of medicine in residence at UCLA from 1972 to 1999 (now emeritus). He was the director of gastroenterology at Cedars-Sinai Medical Center in Los Angeles for 25 years, where he received the chief resident's teaching award, the president's award, and the pioneer of medicine award.
The symptoms of NAFLD and NASH are
identical. They are very bland (not dramatic) and non-specific (can also be
observed in other diseases). They can occur at any adult age and, in children,
usually appear after 10 years of age. Actually, most patients have no symptoms.
They may, however, experience occasional, vague right upper-quadrant abdominal
pain (below the rib-cage on the right side). This pain characteristically is
dull and aching, without a predictable pattern of occurrence. It is not an
intense, sudden, and severe pain, as might occur with, for example, gallstones.
The abdominal pain in NAFLD and NASH is thought to be due to the stretching of
the liver covering (capsule) when the liver enlarges and/or when there is
inflammation in the liver.
In contrast to ALD, HBV, and HCV, symptoms of severe, acute (rapid onset)
liver failure (due to intense hepatitis) are not observed in NAFLD or NASH. The
symptoms and signs of liver failure include yellowing of the skin (jaundice),
intense fatigue, loss of appetite, nausea, vomiting, and confusion.
The classic signs of insulin resistance dominate the physical exam in NAFLD
and NASH. As mentioned above, obesity (especially abdominal obesity) is the most
frequent finding. In addition, patients with long-standing DM2 may have
complications from the
diabetes, such as retinopathy (abnormal blood vessels in
the eye),
kidney (renal) failure,
and coronary artery heart disease. Elevated
blood pressure (hypertension) is frequent.
Acanthosis nigricans, a dark pigmentation of the skin of the armpits and
neck, can be a sign of insulin resistance and is frequently seen in children
with NASH. When the liver is palpated (felt by the doctor), it usually feels
normal. However, when very large amounts of fat accumulate in the liver, it can
be become quite large with a soft, rounded edge that can be easily felt by the
doctor.
The cirrhosis stage of NAFLD usually occurs later in life (age 50 to 60
years), presumably after many years of NASH. Frequently at this stage, patients
have insulin dependent DM2. (With ALD or HBV, in contrast, cirrhosis can
sometimes develop over a short period of time and, therefore, occur earlier in
life.) NASH patients with cirrhosis can be without symptoms (asymptomatic) if
diagnosed early. However, they can have typical signs of compensated or
decompensated cirrhosis.
The signs of compensated cirrhosis include a large, hardened liver, small,
star-shaped vessels (spider angiomata) on the skin of the upper torso, blotchy
redness on the palms (palmar erythema), whitened nails, thin silky hair, loss of
body hair, prominent veins on the abdomen (abdominal collateral veins),
irregular or absent menstruation in pre-menopausal women, and small testes and
enlarged, sometimes painful breasts (gynecomastia) in men. The signs of
decompensated cirrhosis include all the above except that the liver may be
shrunken and there may be swelling of the legs (edema), accumulation of fluid in
the abdomen (ascites), bleeding from veins in the esophagus (varices), and
mental confusion (hepatic encephalopathy).
Fatty liver has also been described in several medical syndromes (groupings
of abnormalities). For example, fatty liver occurs in polycystic ovarian
syndrome, in which polycystic ovaries are associated with obesity, excessive
hair (hirsutism), and insulin resistance. Congenital lipodystrophy syndromes,
which are rare disorders in which the fat in the torso and extremities shifts to
the abdomen, are also associated with an enlarged fatty liver.
Fatty Liver - How Was Diagnosis EstablishedQuestion: The symptoms of fatty liver can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
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